Metastatic Invasive Mole in the Lung Arising from a Cornual Pregnancy / 대한산부인과학회지

Gestational trophoblastic disease is derived from the intermediate trophoblast cells which are arisied from the fetal chorion. The incidence of invasive mole in Korea was about 1.8 per 1000 delivereies. The rate of ectopic pregnancy is about 1.9% of all pregnancies. An ectopic pregnancy located in the cornual portion of uterus occurs in only 2-4% of all ectopic pregnancies. It is rare that the invasive mole is associated with cornual pregnancy. A case of metastatic invasive mole in the lung arising from a cornual pregnancy is reported, which was cured by operation and combination chemotherapy.

Atypical Proliferating Muinous Tumor arising in a Mature Cystic Teratoma / 대한산부인과학회잡지

The borderline tumor is not benign but has low malignant potential, which accounts for 10-15% of all ovarian tumors. The mucinous borderline tumors make up approximately 40% of all borderline tumors. About 5% of mature cystic teratomas of ovary include some with mucinous cystadenoma. The malignant transformation is occurred in about 1-3% of patients who have a mature cystic teratoma. There has been reported frequently about the malignant transformation of a mature cystic teratoma. After the first description of a patient with mucinous borderline tumor associated with a mature cystic teratoma in 1988, the borderline tumorous change of a mature cystic teratoma has been reported rarely. This report presents a patient with atypical proliferating mucinous tumor arising in a mature cystic teratoma.

A Clinical Evaluation of Chlamydia Trachomatis Infection in Women / 대한산부인과학회잡지

OBJECTIVE: Chlamydia trachomatis is one of the most common causative microorganisms in pelvic inflammatory disease. The symptom of Chlamydia infection is nearly absent or weak in many cases, but its complication is clinically very important because of tubal obstruction, infertility, tubal pregnancy, and recurrent pelvic inflammatory disease. This study was performed to investigate the prevalence rate and clinical characteristics of Chlamydia trachomatis. METHODS: From May, 2001 to April, 2002, in Daerim St. Mary's Hospital, OB-Gyn department, the 68 inpatients of pelvic inflammatory diseases and 607 outpatients of routine gynecologic examination were studied on history taking, physical examination, laboratory test, and polymerase chain reaction for the detection of Chlamydia trachomatis. RESULTS: The prevalence rate of Chlamydia trachomatis was 20.6% (14/68) in pelvic inflammatory disease and 8.6% (51/593) in routine gynecologic examination. As regarding the age distribution of Chlamydia trachomatis positive group was the largest portion in the twenties, and symptom-free group was about 40%. Chlamydia infection was related to the history of artificial abortion, and showed no significant difference in parity. Most common site of infection was uterine cervix, and mixed infection rate with other bacteria was 43.1%. The treatments were given medically in 58 cases, surgically in 6 cases, and laparoscopy in 1 case were performed. CONCLUSION: Although the prevalence rate of Chlamydia infection is high in sexually active age group and Chlamydia infection has a serious bad effect on reproduction, the disease detection is difficult because symptom is weak or absent, but it reveals good cure rate. Therefore the screening and treatment of Chlamydia trachomatis are necessary to decrease the prevalence and prevention of complication.

A case of nephrogenic diabetes insipidus caused by obstructive uropathy due to prostate cancer

Nephrogenic diabetes insipidus (DI) secondary to chronic urinary tract obstruction is a rare disease. The exact cause is unknown but it is likely that increased collecting duct pressures cause damage to the tubular epithelium, resulting in insensitivity to the action of arginine-vasopressin (AVP). A 77-year-old man complaining of polyuria and polydipsia was treated with alpha glucosidase inhibitor under the impression of polyuria due to diabetes mellitus. But his symptoms did not improve. Water deprivation and AVP administration study revealed that the patient had nephrogenic DI. Urinary tract obstruction due to an enlarged prostate was suggested as a principal cause of nephrogenic DI. The patient underwent transurethral resection of the prostate and bilateral subcapsular orchiectomy. After surgery, the urine osmolarity was normalized and the patient became symptom-free. We report a case of nephrogenic DI due to obstructive uropathy which was cured by surgery eliminating obstruction.

Differential Factor between Idiopathic Detrusor Instability and Voiding Dysfunction with Normal Uroflow Pattern in Men / 대한비뇨기과학회지

No abstract available.

Primary Bladder Neck Obstruction : Clinical Characteristics and the Effectiveness of Endoscopic Incision of Bladder Neck / 대한비뇨기과학회지

No abstract available.

Management of Penile Curvature Combined with Impotence and Complete Urethral Stricture after Pelvic Trauma / 대한남성과학회지

After pelvic trauma, complications of urethral stricture and organic impotence may develop. Certain cases of these are combined with penile curvature, which treatment method of artificial erection alone is not suitable, because severe penile pain may occur during erection, Therefore proper surgical methods should be added for straightening the penile curvature. After pelvic trauma, complete urethral stricture and organic impotence with penile curvature developed in 3 patients who complained severe pain due to curvature during the intracavernosal injection test. To all, treatment of choice for complete urethral sticture was visual internal urethrotomy for prevention of further development of curvature, and for curvature, Nesbit's penile straightening operations were performed, one by one. All patients could well urinate and enjoy their sexual intercourse after intracavernosal injection of PGE1 or papaverine. We recommend visual internal urethrotomy and the Nesbit's operation as effective methods to treat the case of penile curvature combined with complete urethral stricture after pelvic trauma.

The Study of the Change in the Oxidative System Balance in Preeclampsia / 대한산부인과학회잡지

OBJECTIVE: This study assesses the hypothesis that preeclampsia is associated with the change of oxidative system balance by measuring the lipid peroxidation and antioxidant activity in preeclampsia. METHOD: Venous blood samples were collected from twenty women with preeclampsia and twenty women with uncomplicated pregnancies. Total lipid peroxidation, total antioxidant activity, antioxidant enzyme activity and antioxidant concentration were measured using flow injection-chemiluminescent method. RESULTS: 1. Total lipid peroxidation(PCOOH) was higher in preeclampsia(717.22+/-93.08 pmol/ml) than in normal pregnant(486.86+/-43.15 pmol/ml) (P<0.05). 2. Total antioxidant activity was significantly higher in preeclampsia(46.02+/-5.95 % inhibition) than in normal pregnant(38.59+/-7.57 % inhibition) (P<0.05).3. Antioxidant enzyme, catalase activity in RBC was lower in preeclampsia(346.59+/-82.84 unit/gHb) than in normal pregnant(440.62+/-72.8 unit/gHb) (P<0.05).4. Antioxidant, alpha-tocopherol concentration in RBC was slightly lower in preeclampsia(33.21+/-7.82 ng/gHb) than in normal pregnant(36.06+/-6.86 ng/gH), but there was no statistically significant difference (P<0.05). CONCLUSION: This data seems to show that preeclampsia is associated with an imbalance between the lipid peroxidation and the antioxidant system.

Clinical value of pretreatment serum cyfra 21-1 and SCC Ag levels in cervical cancer patients / 대한산부인과학회잡지

OBJECTIVES: SCC Ag(Squamous cell carcinoma antigen) is so far the most useful tumor marker in assisting clinical diagnosis of cervical cancer and follow-up after therapy. Elevated levels of cytokeratin 19-fragments(CYFRA 21-1) have recently been detected in large proportion of patients with non small cell cancer of the lung, and in particular those with squamous cell carcinoma. This study is to assess the clinical efficacy of CYFRA 21-1 with SCC Ag as the clinicopathologic parameter in cervical cancer. METHOD: Retrospective analysis of the serum tumor markers CYFRA 21-1 & SCC Ag in eighty cervical cancer patients was performed. RESULTS: Cut off values for SCC Ag & CYFRA 21-1 were 1.94 ng/ml, 3.11 ng/ml respectively. Using the cut-off point, the sensitivity, specificity, positive predictive value(PPV), and negative predictive value(NPV) of serum SCC were 55, 95, 97, 46%, respectively. Serum CYFRA 21-1 showed a sensitivity of 45%, specificity of 91%, PPV of 87%, and NPV of 55%. The combination of SCC and CYFRA 21-1 increased the sensitivity to 62%, with a specificity, PPV, and NPV of 72, 75, 58%. Serum levels of both markers were compared with tumor stage, lesion size and were significantly related. In FIGO stage Ib-IIa, the serum levels of SCC Ag & CYFRA were 2.2+/-3.9, 2.5+/-3.6 ng/ml and in FIGO stage IIb-IV, 12.2+/-15.2, 10.8+/-11.2 ng/ml. In 4cm of lesion size, 11.8+/-11.9, 7.7+/-9.3 ng/ml. CONCLUSION: These data seems to show that serum CYFRA 21-1 may be of additional value in assessing the state of disease in some patients with cervical cancer. The prediction of recurrent cervical cancer with SCC Ag were improved by the combination with CYFRA 21-1 but further investigation is needed.

Cystoscopy in the Evaluation of Hematuria / 대한신장학회잡지

Hematuria is a common presentation of bladder cancer. As medical examinations for health screening are becoming more popular, increasing number of patients are found to have hematuria. When to refer these patients to urologists for cystoscopy is a common problem to nephrologists and a matter of debate as well. In fact, many authors differ in their opinions on this issue, especially in cases of microscopic hematuria. Given the fact that the incidence of bladder cancer varies between countries, it will be reasonable that the investigation strategy for Koreans should be determined according to the studies on Korean people. In the present study, we retrospectively analyzed 349 patients who underwent cystoscopic examinations in our institution to investigate causes of microscopic or gross hematuria. Bladder cancer was detected on cystoscopy in 35(15.9%) of 220 patients with gross hematuria, in contrast to patients with microscopic hematuria in whom 2(1.6%) of 129 patients were found to have bladder cancer. Eighty nine percents of cancer patients were male. Bladder cancer was detected even in relatively young patients with gross hematuria, while no bladder cancer was found in patients with microscopic hematuria below 60 years of age. Urine cytology was revealing in 59.5% of cancer patients. Bladder cancer was detected in 71.4% and 76.2% of cancer cases by sonography and IVP, respectively. Urine protein by dipstick was unreliable in predicting the presence of cancer. In conclusion, decision on cystoscopy in patients with asymptomatic microscopic hematuria younger than 50-60 years of age should be made conservatively, while more aggressive diagnostic work up is necessary in patients with gross hematuria regardless of their age.

Study on Expressions of Androgen Receptor and Apoptosis in Human Metastatic Prostate Adenocarcinoma / 대한비뇨기과학회지

PURPOSE: Study on expressions of androgen receptor(AR) and apoptosis in metastatic prostate cancer before antiandrogen therapy may give rise to clue informations that could enable to predict the heterogeneity of androgen dependence. MATERIALS AND METHODS: With paraffin blocks of metastatic prostate cancer(n=31), benign prostate hyperplasia (n=16) and normal prostate(n=5), characteristics of apoptosis positivity and nuclear androgen repceptor expression were evaluated. Prostate cancers were also grouped by Gleason sum into group I(well differentiated;n=7)), II(moderately differentiated;n=9) and III (poorly differentiated; n=15). Apoptosis was expressed by in-situ hybridization technique and AR was evlauated by immunohistochemical method. RESULTS: Study with statistics of median positive rate of apoptosis and AR among three groups, revealed no relationship between expression of apoptosis and AR (correlation coefficient :CE=-0.523, p=0.362 in normal; CE=-0.406, p=0.119 in BPH; CE=-0.022, p=0.905 in cancer). Also there was no correlation between expression of apoptosis and AR in subgroups of cancer. In log-rank survival test, survivals according to the expression of apoptosis showed good survival rate in group of high positive(p=0.013), whereas study of AR showed no significant findings. Histologic findings of apoptotic cell in cancer were different from that of normal and BPH, which distributions of apoptotic cells were even in normal and BPH, but in cancer, these were uneven and collected patterns, which might mean the cell collections of androgen dependent or not. CONCLUSIONS: Good survival in group of high posive apoptosis and eneven collections of apoptotic cells in cancer may have important implications for solving the problems that could predict the heterogeneity of androgen dependence in prostate cancer before antiandrogen therapy, although study of AR is not sufficient to predict the heterogeneity of prostate cancer.

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No abstract available.

No title

No abstract available.

A Case of Self-inserted Intravesical Newspaper during Masturbation / 대한비뇨기과학회지

Various intravesical foreign bodies have been reported in the literature. We report a rare case of intravesical newspaper that was self-introduced through the urethra as a means of masturbation. A 36 year old male patient was suffered from intermittent dysuria and gross hematuria due to self-inserted newspaper in the bladder. The clinical symptoms, diagnostic maneuvers and treatment of intravesical foreign bodies were described.

Usefulness of Voiding Symptom Score and Uroflowmetry as the Screening Methods for Patients with Prostatitis Syndrome / 대한비뇨기과학회지

PURPOSE: Recently, urine reflux into prostate during abnormal micturition has been proved and suggested to be an important pathogenetic factor that evoked the symptoms of prostatitis syndrome. The evaluation of voiding dysfunction in these patients may give the useful information to select the treatment methods or the next step of study. The objectives of this study was to evaluate the usefulness of voiding symptom score and uroflowmetry as the screening methods for patients with nonbacterial prostatitis syndrome. MATERIALS AND METHODS: For patients with prostatitis syndrome, evaluations of urine, prostatic secretion, voiding symptom scores(IPSS: international prostate symptoms score), and uroflowmetry were performed. Patients were divided into 3 groups according to the patterns of uroflow curve[type N; normal bell shape with Qmax(maximal flow rate) > 20ml/sec, type I; irregular shape, regardless of Qmax, type P; plateau shape with Qmaxf15ml/sec]. For patients with cutie patterns of type I and p, G-blockers were tried initially for 1-2 months and the effectiveness of o-blockers according to the changes of IPSS, Qmax and patterns of uroflow cutie was estimated. Patients with the pattern of type N and non-responders to o-blockers were further investigated to rule out any other cause. RESULTS: Among total 64 patients, 55 patients(86%) showed the abnormal uroflow cuties(Type I or P). 34(61.8%) of these 55 patients responded to alpha-blockers with changes of IPSS from 18.3 to 8.1(p<0.001) and of Qmax from 13.gm1/sec to 20.0ml/sec(p<0.001). The response to o-blockers was expected highly in group of type I with more than 10m1/sec of Qmax and less than 20points of IPSS(14.7folds). Of the 9 of type N patients, 6 were revealed to have idiopathic detrusor instability and 18 of 21 non-responders to alpha-blockers were diagnosed to have the bladder neck obstruction. CONCLUSIONS: The results that the effectiveness to o-blockers and the possibility of other disease could be characterized by IPSS and uroflowmetry suggest IPSS and uroflowmetry may be the useful screening methods for patients with prostatitis syndrome.

Insertion of Urethral Wallstent (MemothermR) at External Urethral Sphincter for the Treatment of Patients with Complicated Detrusor Sphincter Dyssynergia / 대한비뇨기과학회지

In patients with spinal cord injury, detrusor sphincter dyssynergia is a common and troublesome problem that may evoke progressive deterioration of upper urinary tract and urinary tract infection including sepsis. Instead of external sphincterotomy, urethral wallstent may be the useful treatment for the patients with detrusor sphincter dyssynergia refractory to conventional treatment. In addition, this method has some advantages of less invassive, less morbid and simpler technique than other treatment methods. We report our preliminary results of the urethral wallstent(MemothermR) for the treatment of 2 patients with complicated detrusor sphincter dyssynergia.

Kidney Transplant Program of the Ajou University Hospital / 대한이식학회지

The Ajou University Hospital opened in September, 1994. We performed our first kidney transplant in June 1995. So far, we have performed 40 kidney transplants with all of the recipients having excellent renal function at present. We now report the various clinical aspects of kidney transplant recipients operated at the Ajou University Hospital. The kidney transplant program at the Ajou Univerisity Hospital has several characteristics in comparison to other hospitals in Korea. One of them is a higher proportion of cadaveric donor (37.5%). Another is ALG (anti-lymphocyte globulin) induction of immunosuppression in the selected cases of cadaveric renal transplantation. The incidence of early rejection was significantly decreased by the introduction of ALG induction in cadaveric renal transplant compared with cyclosporine induction. We have aggressively performed the renal allograft biopsies in cases of early graft dysfunction or unexplained change in graft function during the follow-up. In cases of delayed graft function, we have done routine graft biopsies at regular intervals, which helped detect early episodes of acute rejection superimposed upon severe acute tubular necrosis. The occurrence of polycythemia (20%) after renal transplantation was primarily controlled by ACE(angiotensin-convertine enzyme) inhibitor except in one case of chronic rejection. As a result of well coordinated efforts by all the members in the transplant team, all 40 patients have done exceptionally well, and the serum creatinine levels in all the patients are under 2.0 mg/dl.

Kidney Transplant Program of the Ajou University Hospital / 대한이식학회지

The Ajou University Hospital opened in September, 1994. We performed our first kidney transplant in June 1995. So far, we have performed 40 kidney transplants with all of the recipients having excellent renal function at present. We now report the various clinical aspects of kidney transplant recipients operated at the Ajou University Hospital. The kidney transplant program at the Ajou Univerisity Hospital has several characteristics in comparison to other hospitals in Korea. One of them is a higher proportion of cadaveric donor (37.5%). Another is ALG (anti-lymphocyte globulin) induction of immunosuppression in the selected cases of cadaveric renal transplantation. The incidence of early rejection was significantly decreased by the introduction of ALG induction in cadaveric renal transplant compared with cyclosporine induction. We have aggressively performed the renal allograft biopsies in cases of early graft dysfunction or unexplained change in graft function during the follow-up. In cases of delayed graft function, we have done routine graft biopsies at regular intervals, which helped detect early episodes of acute rejection superimposed upon severe acute tubular necrosis. The occurrence of polycythemia (20%) after renal transplantation was primarily controlled by ACE(angiotensin-convertine enzyme) inhibitor except in one case of chronic rejection. As a result of well coordinated efforts by all the members in the transplant team, all 40 patients have done exceptionally well, and the serum creatinine levels in all the patients are under 2.0 mg/dl.

Two Cases of Arterial Priapism / 대한남성과학회지

Priapism has been classified as primary (idiopathic)and secondary according to etiology. Hemodynamically, it can be separated into two distinct types: low-flow (ischemic) and high flow (non-ischemic). In the latter type, the most common cause is blunt genital trauma, and selective cavernosal artery embolization has been the most effective therapeutic method. Two cases of high-flow arterial priapism are presented. Both cases were post-traumatic and were managed with selective cavernosal artery embolization, with excellent return of premorbid levels of erectile function.

Two Cases of Arterial Priapism / 대한남성과학회지

Priapism has been classified as primary (idiopathic)and secondary according to etiology. Hemodynamically, it can be separated into two distinct types: low-flow (ischemic) and high flow (non-ischemic). In the latter type, the most common cause is blunt genital trauma, and selective cavernosal artery embolization has been the most effective therapeutic method. Two cases of high-flow arterial priapism are presented. Both cases were post-traumatic and were managed with selective cavernosal artery embolization, with excellent return of premorbid levels of erectile function.